Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Polish Journal of Surgery

The Journal of Foundation of the Polish Journal of Surgery

12 Issues per year


CiteScore 2016: 0.29

SCImago Journal Rank (SJR) 2016: 0.166
Source Normalized Impact per Paper (SNIP) 2016: 0.207

Open Access
Online
ISSN
0032-373X
See all formats and pricing
More options …
Volume 86, Issue 12

Issues

The Efficacy of Alcohol-Antibiotic Lock Therapy for Treatment of Catheter Related Bloodstream Infections in Patients Receiving Home Parenteral Nutrition

Michał ławiński
  • Corresponding author
  • Department of General Surgery and Clinical Nutrition, Warsaw Medical University Kierownik: dr hab. J. Sobocki
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Krystyna Majewska
  • Department of General Surgery and Clinical Nutrition, Warsaw Medical University Kierownik: dr hab. J. Sobocki
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Iwona Fołtyn
  • Department of General Surgery and Clinical Nutrition, Warsaw Medical University Kierownik: dr hab. J. Sobocki
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Aleksandra Gradowska
  • Department of Personality, University of Social Sciences and Humanities in Warsaw Kierownik: prof. dr hab. J. Trzebiński
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2015-03-01 | DOI: https://doi.org/10.1515/pjs-2015-0002

Abstract

In patients with chronic gastrointestinal tract failure, requiring access to the venous system, the subsequent catheter re-insertion are leading to large veins thrombosis impeding or preventing the insertion of another catheter and exposing patients to the risk of complications. Understanding the pathophysiology of catheter-related infections, enabled to use methods allowing to eradicate the source of infection without removal and replacement of central catheter with a new one. In our center, for many years we have been using an alternative method involving implementation of the alcohol-antibiotic lock in the treatment of infections. This method is based on the assumption that the destruction of biofilm with concentrated alcohol will enable antibiotic penetration and killing other microorganisms. Treatment with alcohol-antibiotic lock lasts from 8 to 10 days and involves filling the catheter with 96% alcohol followed by a solution of the antibiotic of high concentration.

The aim of the study was to evaluate the efficacy of treatment of catheter-related bloodstream infections with two methods (catheter replacement with a new one and the alcohol-antibiotic lock therapy) in patients receiving home parenteral nutrition (HPN).

Material and methods. 428 HPN in the period from 1 January 2005 to 31 December 2010. Among which 240 (56%) of women with an average age of 56.5±16 years and 188 (44%) of men with an average age of 54±17 years. The indications to HPN were as follows: short bowel syndrome in 298 (70%) patients, multilevel obstruction of the gastrointestinal tract in 52 (12%), postoperative gastrointestinal fistulas in 48 (11.2%), malabsorption syndrome in 17 (4%), motility disorders in 6, cachexia in 4 and radiation enteritis in 3 patients.

Results. In 247 (57.5%) from 428 patients, no episode of catheter-related bloodstream infection was found, while 181 were diagnosed with 352 episodes of catheter-related bloodstream infections. In 40 (9.4%) from 428 patients, 168 (47.8%) episodes have been found - almost a half. The mean duration of treatment of patients receiving home parenteral nutrition, starting from the first episode of catheterrelated bloodstream infection, in 48 patients treated with the lock was equal to 1053+748 days, and in 133 patients treated with catheter replacement was equal to 952+709 days (t-test p = 0.62).

Conclusions. The survival time of patients treated with alcohol-antibiotic lock is the same as in patients treated with the catheter removal and insertion of the new one. The use of alcohol-antibiotic lock to treat catheter-related bloodstream infections in order to eradicate selected microorganisms that colonize the lumen and cause an infection, is as effective as catheter replacement with a new one.

Keywords: home parenteral nutrition; alcohol-antibiotic lock therapy; catheter related bloodstream infections

References

  • 1. Mermel LA, Allon M, Bouza E et al.: Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Jul 1; 49(1): 1-45. No abstract available. Erratum in: Clin Infect Dis. 2010 Feb 1; 50(3): 457. Clin Infect Dis 2010 Apr 1; 50(7): 1079.CrossrefGoogle Scholar

  • 2. Manierski C, Besarab A: Antimicrobial locks: putting the lock on catheter infections. Adv Chronic Kidney Dis 2006 Jul; 13(3): 245-58.Google Scholar

  • 3. Del Pozo JL: Role of antibiotic lock therapy for the treatment of catheter-related bloodstream infections. Int J Artif Organs 2009 Sep; 32(9): 678-88.PubMedGoogle Scholar

  • 4. Segarra-Newnham M, Martin-Cooper EM: Antibiotic lock technique: a review of the literature. Ann Pharmacother 2005 Feb; 39(2): 311-18.CrossrefGoogle Scholar

  • 5. Crnich CJ, Halfmann JA, Crone WC, Maki DG: The effects of prolonged ethanol exposure on the mechanical properties of polyurethane and silicone catheters used for intravascular access. Infect Control Hosp Epidemiol 2005 Aug; 26(8): 708-14.Google Scholar

  • 6. Johnston DA, Walker K, Richards J, Pennington CR: Ethanol flush for the prevention of catheter occlusion. Clin Nutr 1992 Apr; 11(2): 97-100.CrossrefPubMedGoogle Scholar

  • 7. Mermel LA, Allon M, Bouza E et al.: Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009 Jul 1; 49(1): 1-45.CrossrefGoogle Scholar

  • 8. Sitges-Serra A, Girvent M: Elimination of intraluminal colonization by antibiotic lock in silicone vascular catheters. Nutrition 1998 Sep; 14(9): 715- 16.Google Scholar

  • 9. Messing B, Man F, Colimon R et al.: Antibioticlock technique is an effective treatment of bacterial catheter-related sepsis during parenteral nutrition. Clin Nutr 1990 Aug; 9(4): 220-25.CrossrefPubMedGoogle Scholar

  • 10. Johnson DC, Johnson FL, Goldman S: Preliminary results treating persistent central venous catheter infections with the antibioticlock technique in pediatric patients. Pediatr Infect Dis J 1994 Oct; 13(10): 930-31.PubMedCrossrefGoogle Scholar

  • 11. Fortún J, Grill F, Martín-Dávila P et al.: Treatment of long-term intravascular catheter-related bacteraemiawith antibiotic-lock therapy. J Antimicrob Chemother 2006 Oct; 58(4): 816-21.PubMedGoogle Scholar

  • 12. Rijnders BJ, Van Wijngaerden E, Vandecasteele SJ et al.: Treatment of long-term intravascular catheter-related bacteraemia with antibiotic lock: randomized, placebo-controlled trial. J Antimicrob Chemother 2005 Jan; 55(1): 90-94.PubMedGoogle Scholar

  • 13. Fernandez-Hidalgo N, Almirante B, Calleja R et al.: Antibiotic-lock therapy for long-term intravascular catheter-related bacteraemia: results of an open, non-comparative study. J Antimicrob Chemother 2006 Jun; 57(6): 1172-80.Google Scholar

  • 14. Viale P, Pagani L, Petrosillo N et al.: Italian Hospital and HIV Infection Group.: Antibiotic locktechnique for the treatment of catheter-related bloodstream infections. J Chemother 2003; 15(2): 152-56.PubMedGoogle Scholar

  • 15. Castagnola E, Bandettini R, Lorenzi I et al.: Catheter-related bacteremia caused by methicillinresistant coagulase negative staphylococci with elevated minimal inhibitory concentration for vancomycin. Pediatr Infect Dis J 2010 Nov; 29(11): 1047-48.Web of ScienceGoogle Scholar

About the article

02-091 Warszawa, ul. Żwirki i Wigury 61


Received: 2014-09-29

Published Online: 2015-03-01


Citation Information: Polish Journal of Surgery, Volume 86, Issue 12, Pages 563–568, ISSN (Online) 0032-373X, DOI: https://doi.org/10.1515/pjs-2015-0002.

Export Citation

© 2015 Michał ławiński et. al.. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. BY-NC-ND 3.0

Comments (0)

Please log in or register to comment.
Log in